Ratios: My Ast level is 17 and ALT is 1... - British Liver Trust

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Hayleigh79 profile image
Hayleigh79

My Ast level is 17 and ALT is 11, not sure if I have worked this out right as the ratio being 1.5? Is this an abnormal ratio does any one know please

I have no diagnosis but have had lots of abnormal bloods over the years, doctor says they are all within range since stopping drinking & I’ve not to worry about the ratio

25 Replies

An elevated ratio can indicate a liver may have been damaged by alcohol intake. It doesn't necessarily indicate the full extent of the harm or even necessarily indicate cirrhosis. See the link below for a discussion.

5 years ago I had a liver test and an elevated AST:ALT ratio, but the individual values were in a normal range. I was not warned, kept drinking, and spent the last 3 months sick with many symptoms of a failing liver and being referred to many specialists. Not optimistic about my future.

If you have good blood results otherwise and no specific liver symptoms, all you can do is to keep from introducing any new insults to the liver. Your liver should be able to maintain, and you should be able to live a perfectly healthy life from a liver point of view.

As always, if you have specific concerns, follow up with your docs. Just know that many GPs are unfamiliar with specifics regarding the liver like the De Ritis ratio (mine wasn't--of course, I am responsible for my drinking, but a warning would have been well received).

ncbi.nlm.nih.gov/pmc/articl...

I should add that individual baselines can vary, and in women it is possible to have a perfectly healthy liver and a ratio of even 1.7, according to the article. And in any event, even *some* damage to a liver from drinking is unlikely to ever affect you unless you cross over into cirrhosis, and even then unless your liver decompensates, which can take many years even with cirrhosis.

So again, if you have no symptoms, and have quit drinking, be healthy and enjoy your life 🙂.

Thanks so much for your reply

So does the individual results of AST and ALT not really mean much is it more the overall of them both? Sorry you just seem more clued up than me! I try to stay away from google and ask my doctors a lot but I always get told the same, everything is ok!

The only real symptom I have is ongoing upper right side back pain occasionally going into shoulder I’ve related that to liver pain but they tell me it’s not 🤷‍♀️

So hard to know where to turn for advice when you feel yourself something isn’t right

That's not necessarily a liver symptom. Do you have any risk factors for liver disease? You mentioned stopping drinking. If you didn't drink daily and for years, that's probably not a risk. A glass of wine here and there is not "drinking" in this context.

Still, your docs will ultimately have toncheck you out. Don't just focus on the liver, as it may be other things, or just an annoying pain that comes with living.

I drank daily for many years something I’m not proud of but am trying to make big changes now I just hope it’s not too late

I guess my pain could be anything at all but like a lot of us who have abused our bodies and had abnormal results you do worry it is liver related

I feel like I am annoying my doctors and they continuously use the word anxiety but I’m sure there’s a lot of people who’s been anxious about symptoms that have turned out to be something, sometimes you have to be aware of changes and signs in your body to know there’s something wrong and make changes

How many years? A decade? Two? A couple years is almost certainly not enough, if not impossible. How much alcohol? A glass daily? A bottle? Three?

If you don't have any pressing/specific symptoms (vague pain or fatigue usually won't be enough for docs to have a sense of urgency) docs may not be too interested as there would be nothing they could do in any case, other than to tell you to eat well and not drink/smoke. And again, women tend to have a bit higher AST:ALT ratio than men naturally--even if you have some liver damage, it may never cause you health problems. Of course, every case is unique and only your docs can diagnose you. If your liver was failing, you'd know.

Specifically regarding enzyme levels--high levels suggest ongoing damage. A high ratio, even with normal levels, can indicate long term damage has been done.

It all has me totally confused! All enzyme levels have been normal for last 2 lots of bloods but who knows what damage could of been already done as you say.

I prob drank a bottle of wine most days for 15 years, give odd times I had small breaks off it but mainly on it, I just wish I could turn back the clock

If you don't have specific symptoms, you're likely fine. I see you're getting an MRI--you should know more then. In the meantime, if you have no *specific* symptoms, you should be fine.

Liberty82 profile image
Liberty82 in reply to Hayleigh79

I was seriously worried about mine, it was 1.3 and I had so many symptoms but always bloods within range, 2 normal fibroscan and a normal cat scan. I spoke to the consultant about this and he said that basically the ast/alt ratio is of no concern if the bloods are all within normal range, he was very clued up on this and said he'd written a few papers on it. Basically its null and void if your bloods are within range, and yours are. As a pp said look after your liver from now on, I have quit drinking completely and try to lead a healthier life style although I still have symptoms but I try not to worry about it on a daily basis. I am also pregnant which reassures me that I can't be that bad if im able to concieve naturally as I wasn't able to for years. Look after your liver and it will look after you, and don't worry about the ast alt ratio. X

Hayleigh79 profile image
Hayleigh79 in reply to Liberty82

Oh thank you so much for your reply, that’s very reassuring to read. I read different things and get myself all confused and then doubt my results. I’m really trying hard to take care of my liver, be healthy and get out walking each day & hopefully it will ease the worry over my symptoms which I suppose could be anything. Congratulations on your pregnancy that’s lovely news and yes your obviously in good health to conceive so that’s another plus, enjoy every moment and thanks again x

Liberty82 profile image
Liberty82 in reply to Hayleigh79

Thank you x

99problem profile image
99problem in reply to Liberty82

What are ur symptoms if u don’t mind my asking

Hayleigh79 profile image
Hayleigh79 in reply to 99problem

Course not, I’ve had ongoing mid to upper right back pain for over a year now it’s there every day even when resting, occasionally this can go into my right shoulder, it’s a pain I find hard to describe, sometimes it is dull and throbbing other times like a burning feeling. I often get cold flushes thru my body, loss of feeling in one of my fingers and slight itching

Liberty82 profile image
Liberty82 in reply to 99problem

My symptoms were hot flushes and heat coming off the liver area worsened by medication or alcohol, oily stools, liver pain in my back and under my ribs that sometimes stretched to my shoulder, cramping limbs, nail changes (pale with brown band), hair loss, gum problems, dead cement like legs at night, bile taste in mouth, night sweats. More that I can't remember off the top of my head but it has been very frightening for me. And even though the tests were coming back normal scary things were happening to my body. Sometimes there just doesn't seem to be any answers.

99problem profile image
99problem in reply to Liberty82

I totally agree with u . Answers seem scarce from my docs as well. Levels are normal but I’ve got constant dull pain that tends to get more severe as I sit in my desk or eat crisps or fatty food. For the most part I’ve overhauled my life into a healthier one. I jog 5 days a week and try to eat better but the pain is persistent . Back and front . I pray you find some relief if even for a day at a time . I miss the days where eating my favourite treat didn’t make me feel like I was dying . I did get blood drawn for liverfast the other day so hopefully the results are reassuring to some extent . My docs here in Florida don’t want to move forward with a fibroscan or biopsy. The system is for profit. If you are rich you get to live I guess .

99problem profile image
99problem in reply to 99problem

Also I was 240 lbs wen I was diagnosed with an enlarged fatty liver . I am now 176 lbs

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You should schedule an abdominal ultrasound if you’re experiencing pain. When I first experienced discomfort there, I had my ultrasound within 5 days and results within 48 hours. I got blessed by finding a team of doctors in one the leading liver disease hospitals in the country. If you feel something is off, always follow up with the doctor.

Hayleigh79 profile image
Hayleigh79 in reply to Hidden

Thank you

I’ve had an ultrasound which came back normal so I’m at a loss as to what it is I’ve also had ELF test and they came back normal but still the pain persists every day for 16mth

Waiting of appointment for MRI

The De Ritis ration for AST : ALT is used when liver enzymes are elevated as one of many factors in determining the underlying cause of liver damage and to help assess prognosis. It is not clinically relevant when both levels are in the normal range and in the absence of other out-of-range values such as ALP, albumin and GGT.

The De Ritis ratio can have many uses when enzyme levels are within their normal ranges.

ncbi.nlm.nih.gov/pmc/articl...

Yes as discussed last time this link was cited, the singular example this paper references with regard to normal ranges is that it is possible with NASH. This isn’t good evidence to cite it here in support of it being an indicator of alcohol-induced liver damage; it is not.

The article doesn't just talk about NASH, it references ALD, both chronic and acute, as well as viral causes of liver disease. When the paper addresses the De Ritis ratio exclusively in the context of elevated enzyme levels, it states so specifically. It's would be bizarre to read that limitation into the whole article where it is expressly mentioned only in some spots. From the article:

"...there aren’t any generally accepted reference intervals for the ratio and indeed it is difficult to define ‘healthy’ limits for the ratio if its main application is when transaminases are abnormal."

Meaning, reference to a healthy ratio probably only makes sense when enzyme levels are normal--a far cry fromthe claim that the ratio has value from a prognostic point of view *only if* enzymes are elevated. The paper does mention that an elevated ratio in alcoholic liver disease may indicate cirrhosis that is, indicate the severity of the disease--of course, that doesn't mean that the ratio alone can *diagnose* alcoholic liver disease. One would probably need history, symptoms, and perhaps other tests as well to get there. But, the ratio is not only relevant--in ALD or other contexts--when enzymes are elevated.

The De Ritis ratio is used to identify eligible cirrhotics for this clinical trial, regardless of whether enzyme levels are elevated:

clinicaltrials.gov/ct2/show...

I hope they can find the cause of your pain. It seems you can confidently listen to your doctor that it isn’t liver based on all the tests you’ve had. Have faith in the medically trained people and try to tone down how much you listen to the internet. Take care.

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